Changes in Welfare Rules Affect Medicaid Usage:
An Interview with Dr. James Quilty

Aired July 21, 1999

David C. Barnett–Joining us on the phone is James Quilty, director for Metro Health at Home in the Metro Health system. He also sits on the State Medical Care Advisory Committee. Good morning, Dr. Quilty.

James Quilty–Good morning.

DCB–Why do you think people aren't using Medicaid?

JQ–Well, we don't have a real handle on that, but it would appear that if there is a single factor, it has been the change in the welfare rules. I think it's extremely important, David, to recognize the history of this whole program. It wasn't until 1986 that there was a cleavage between the receiving of food stamps and the monetary income with the AFDC program and Medicaid. Up until that time, from the time Medicaid was put together in '65 until '86, unless you were on AFDC, you could not get Medicaid, so when that was cleaved, that was a key part of the whole program. Now, what has happened in the last two years with the change in the welfare rules to Ohio Works First, many of the persons are under the erroneous assumption that as soon as their food stamps and their monetary benefit is cut, then they no longer have the health care benefit, and that probably is responsible for 50-60% of all the dropping out.

DCB–With all the problems and issues that people coming off of welfare have, is it real to expect they'll be able to navigate these sorts of changes and these different ways of looking at rules, which are a mystery to most of us as well?

JQ–Yes. I heard earlier this morning some of Ms. Baer's report, and the speakers at that time did point out some significant problems. I think that our job, though, as a society is to try to get the babies into the world healthy and to get kids taken care of, and so what we have to do is to sift through the various causes for the not signing up and not getting the care, and to develop better ways of doing that. I think we have to treat each of our people as if they are on Medicare, if you will. Medicaid, back in that history if I may just a second, was set up as everybody was beneficiaries on Medicare, and then as a last-minute part of that program that President Johnson put through there, they thought of the kids, and so the Medicaid was put in and these kids and pregnant women were called participants, and there was a distinction between that, and what we need to mover towards now is doing away with that distinction. These are persons, the majority of whom based on our welfare reform and based on their value as a human being need to be treated as human beings, and I can tell you from talking personally with the directors of our Department of Health and Nutrition in Cuyahoga County that this is indeed the route that they are trying to go so we can meet the needs of these people in a very respectful way and make sure that their children are healthy and able to learn when they get to school.

DCB–What can we do to boost the enrollment, and should we boost the enrollment in Medicaid?

JQ–The second question first, if I may.

DCB–Sure.

JQ–We absolutely need to. There's a direct association between the health of students and their ability to learn in the classroom, even their attendance in the classroom, and so if we are able to get all of the children into what we in pediatrics call a medical home, then our opportunity to have that family, have someone that they can contact, take care of simple types of things like immunization so they don't have to be out of school for several days to several weeks while they're navigating the system, that should help, so I think that's the should part. The other part is more of a philosophical thing, David, and I would suggest that the answer to that is yes, we should make an effort to get all of the folks on the care. This is a program that is funded 40 cents on state dollars, 60 cents federal dollars, and administered by the state, in contrast with Medicare, which is totally a federal program, so that for the cost-40% of the cost of taking care of the medical care, Ohio can guarantee that it's children have a greater opportunity to get to school healthy.

DCB–James Quilty is director for Metro Health at Home in the Metro Health system, and he also sits on the State Medical Care Advisory Committee. Thanks for joining us this morning.

JQ–Thank you.